So saw the doctor which was a complete waste of time. It wasn't the doctors fault, simply had no idea about the type of injury I may or may have sustained and wound up educating him the entire visit. He performed a basic evaluation: Put pressure with his index finger the entire length of my hand down to the tip of my ring finger checking for any pain. There was none. Then he place both his index and middle fingers in the center of my open hands and asked me to squeeze as hard as I could. Again no pain.

The doctor ended up giving me a referral to see a hand specialist that specializes in the hand and made an appointment for Wednesday.

Giving the physician the benefit of the doubt, it wasn't a waste of time. He was able to rule out other potential issues before sending you to a hand specialist. It seems straight-forward from the outside, but as many people can attest to, sometimes what looks like an obvious X is a presentation of something else entirely. Being able to rule-out those things is what makes a great primary care physician great.

All that said, yes, it was pretty obvious you needed to see a hand-specialist, and in your case it was probably not that useful to go through a gatekeeper. But from the public health/health-care rationing (because that really is what its about, though the idea is not a bad thing in and of itself), the system is needed.

Good luck with your ortho injury! Hopefully you'll get lucky- my hand specialist, though not a climber himself, is a young athletic guy (like most orthos), and climbing is one of the few sports that really intersects with his speciality, so he's really done a lot of research and seems to have figured out a lot, both about injuries and about the sport in general.

I saw the hand specialist today. I explained to him what I may have done and he was impressed that I was educated in the types of hand injuries climbers risk and my injury. He couldn't believe that I knew so much about it and even asked why that was.

He proceeded to give me a thorough hand evaluation once he was done taking notes during my explanation of how I may have injured my finger.

He started off by feeling the tops of my fingers, where he said he felt some bone spurs and took it as a possible sign of arthritis. He said I was too young for arthritis to be developing so he was concerned.

He then had me place my hands and fingers in various positions to test the ROM of each finger. Afterward, he pushed on certain spots having me stop when I felt any pain. He then used a hammer-like device to trigger some sort of nerve sensation. He then had me bend my wrists back to back with my hands pointing down and had me hold there for a minute to see if anything would go numb. He then had me hold my fingers in various positions and grips where he then had me resist his own finger's pull and push motions.

After that, the Dr. used a tiny device with dull points coming out the center in order to measure sensitivity. He did 2 tests, 1 where he would have me watch and the second, would have me close my eyes. I was supposed to differentiate between 2 types of touches, 1 point, or 2 points.

After this was all said in done, he had me squeeze this device with each hand which measured the amount of lbs squeezed.

Finally, he took some X-Rays which turned out to be negative for arthritis then gave me his diagnosis.

He said that I don't have any pulley strains or tears. He said that the DIP joint is stiff and seems to be the problem. He said I have lost ROM in the tip of that finger because I can't fully straighten it. He didn't tell me how many degrees it was off, but he said it's enough to indicate that the joint is stiff and that's where my pain is coming from. He told me I probably won't get the ROM of motion back but told me how to treat it.

He asked me to take off 4 weeks, or 1 month from climbing then start back slowly. For my treatment, he said you can soak your hand in warm water twice a day. He then suggested I could buy a wax dipping machine, that allows you to dip your hands in melted wax, and once the hand is coated in wax, take it out and let the wax sit on the hand until you no longer feel it. Then peel the wax off.

He told me that when I get back to climbing, to tape around the joint, and can tape around the middle join as well. He recommended I use the following type of wrap:

And he also did quite a bit of two-point discrimination testing. These are standard clinical tests for neuropathies, and it's good to have them ruled out.

Sounds like he also manually muscle tested the intrinsic muscles of the hand, but it's hard to tell without having seen what the actual "various positions of the hand" you describe actually were. Intrinsic testing is likely though. (you can google "lumbricals" and "interossei" and see if the tests look familiar).

Climbers certainly develop bony hypertrophy in the fingers as a result of the enormous forces we put on our fingers. This may well be why he thought he felt "arthritis" in your fingers.

Remember that pulley injuries are almost completely unknown outside of the climbing population, and it is entirely possible that even a specialist has never seen this injury. If the strain is minor, the diagnosis will be exceedingly difficult, and maybe impossible with good reliability.

I'm glad you got some more info, though. Thanks for sharing it here, and stay in touch regarding your progress.

EDIT:

There is nothing you describe that sounds like a test that would stress the pulleys...EXCEPT THIS, which you said in the OP:

In reply to:

I took more & longer breaks between sends but soon as I tried to climb anything with crimps or difficult, the pain would be localized to my ring finger, and it was not manageable.

Crimping directly puts strain on pulleys. That, to me, is the best test for pulley injuries. And yours is (or was) positive for reproduction of symptoms.

Agilis, I am a physiotherapist as well and read through this whole post, and totally agree with all Onceahardman said. I still don't think according to everything you described the specialist did that you can rule out a pulley injury.

I would also add that for most tendon injuries an eccentric strengthening programme could be very beneficial. This could be done by doing a crimp position of the fingers and using the other hand to slowly open up (straighten) the fingers - this will cause a type of elongation-contraction. You could try this in accordance with the other principles already mentioned regarding pain/inflammation etc.

First, the tests you both mentioned was exactly what he did. The link you linked me to Onceahardman was exactly what he did. I'm impressed I explained that so well :) Anyways, really appreciate both your input and insight.

Now I thought I mentioned the pulley test but I can see that I didn't touch on it like I should have and I apologize for that.

The test, now that I think of it, perhaps it was 2, that the specialist did to test my pulleys was first, he used firm pressure on the bottom of my fingers where the pulley locations were to see if I felt any pain. I told him I felt slight pain, located right where my finger meets the palm, but it was barely there, and from a scale 1 to 10, I told him it was like a 1.

He then had me hold my right hand in a crimp like position and had me pull against his fingers which didn't result in any pain from the pulleys, but I was able to pin-point the joint as the location of the pain. This is exactly what qtrollip suggested I do, only instead of me opening my hand, the specialist was the resistance.

Another test he did was he took my fingers and checked for side to side movement in the joint. I believe that was to test for the integrity of the collateral ligaments.

With that added information, any change of opinion? I really am sorry I forgot that information.

First, the tests you both mentioned was exactly what he did. The link you linked me to Onceahardman was exactly what he did. I'm impressed I explained that so well :) Anyways, really appreciate both your input and insight.

Now I thought I mentioned the pulley test but I can see that I didn't touch on it like I should have and I apologize for that.

The test, now that I think of it, perhaps it was 2, that the specialist did to test my pulleys was first, he used firm pressure on the bottom of my fingers where the pulley locations were to see if I felt any pain. I told him I felt slight pain, located right where my finger meets the palm, but it was barely there, and from a scale 1 to 10, I told him it was like a 1.

He then had me hold my right hand in a crimp like position and had me pull against his fingers which didn't result in any pain from the pulleys, but I was able to pin-point the joint as the location of the pain. This is exactly what qtrollip suggested I do, only instead of me opening my hand, the specialist was the resistance.

Another test he did was he took my fingers and checked for side to side movement in the joint. I believe that was to test for the integrity of the collateral ligaments.

With that added information, any change of opinion? I really am sorry I forgot that information.

Here's what I think:

If crimping duplicates (or duplicated) your symptoms, then a pulley injury is certainly "in play". The doc put you in a crimping position, but only loaded the joints up to the amount of force that his fingers could apply, rather than your entire bodyweight.

You need to load the position sufficiently to duplicate symptoms. A pulley strain is thus not ruled out.

Now, also still in play is this "stiff" DIP joint. If extending the DIP under load (as in crimping) duplicates your symptoms, then that would lend credence to the specialist's opinion. But, if the problem is purely the stiffness of the DIP, then (follow me here), the position of the PIP should be irrelevant.

That is, you should be able to duplicate symptoms by moving the DIP whether the PIP is flexed or not.

In crimping, the PIP is very flexed, while the DIP is extended, which puts maximal outward force on the pulleys, and would be expected to reproduce symptoms for a pulley injury.

If we assume that crimping forces are "normal", (which is arguable), then painful crimping would result from loading damaged (abnormal) structures by crimping. But the end-range extension of the DIP would also not rule out a stiff DIP...UNLESS, the pain of extension goes away when you remove the flexion on the PIP.

sorry, man. Maybe use the time to try out sonething you have wanted to do, but didn't have the time, secondary to how time-intensive climbing can be.

Fly fishing. Peak bagging. Extreme minimalist backpacking. (i've heard of people doing a week outside with less than a 20 lb pack!)

Indeed, I've already got the back porch ripped up and will be replacing the rotten boards. That's only one of many projects that will likely get done in the upcoming weeks and months. What fun.

In reply to:

good luck, keep your spirits high, don't get too low. If you have questions, I'm glad to help, but I'm sure i've expressed many opinions on the subject here already

Thanks very much. I've got a nice metal brace I've fashioned that supports the finger very well. I only use it when I'm working with my hands (like the back porch I'm ripping up) or during the day when I'm working (I'm a code monkey, so lots of typing). I take it off the rest of the time, as per your suggestion to let the finger do some work, although I favor it whenever that hand needs to hold something.

There's surprisingly little pain and swelling. It aches a little if I've used it a lot, and if I accidentally grab for an instant with it I get a little sharper pain. But mostly it doesn't hurt at all, it just feels... weird.

Hoping if I'm good to it it will heal quickly.

But yes, in the meantime, I'll keep busy. After all, that homebrew ain't gonna brew itself.

I iced for a good chunk of the first six hours after the injury (well, after the nice 45 minute jog to get back to the car), and then once or twice for the next couple of days. Haven't iced for the last two days, and unsure about whether I should.

To my knowledge, this will increase blood flow to subcutaneous structures, but probably not to deep structures.

Well, the pulleys are pretty much just sections of tendon sheath that are reinforced/thicker, right? So wouldn't you consider them subcutaneous? So far as I can tell, the tendon itself is fine - it's just the pulley that's ripped. But maybe the problem is the section where the structure is supposed to attach the the bone, and maybe that's too deep? I dunno, I'm getting way out of my depth (pardon the pun) here.

Okay, it's a month later, and it seems to have healed enough to be able to take a tiny bit of force without pain, and a little more when I'm taping to support the pulley. So I'd like to move on to the active rehab phase.

What are some good rehab exercises I could do to help things along? The more specific the info the better. And in doing such exercises, would it be better to tape to support the ripped pulley, or no?

Okay, it's a month later, and it seems to have healed enough to be able to take a tiny bit of force without pain, and a little more when I'm taping to support the pulley. So I'd like to move on to the active rehab phase.

What are some good rehab exercises I could do to help things along? The more specific the info the better. And in doing such exercises, would it be better to tape to support the ripped pulley, or no?

Thanks!

GO

I think taping while doing rehab exercises would sort of defeat the point. Just keep the intensity of the exercises, I recommend theraputty, low enough to avoid pain.

Okay, it's a month later, and it seems to have healed enough to be able to take a tiny bit of force without pain, and a little more when I'm taping to support the pulley. So I'd like to move on to the active rehab phase.

What are some good rehab exercises I could do to help things along? The more specific the info the better. And in doing such exercises, would it be better to tape to support the ripped pulley, or no?

Thanks!

GO

I think taping while doing rehab exercises would sort of defeat the point.

That certainly makes sense, and is what I would assume, but I was kind of looking for expert opinions, since there are some very knowledgeable people who post here.

Okay, it's a month later, and it seems to have healed enough to be able to take a tiny bit of force without pain, and a little more when I'm taping to support the pulley. So I'd like to move on to the active rehab phase.

What are some good rehab exercises I could do to help things along? The more specific the info the better. And in doing such exercises, would it be better to tape to support the ripped pulley, or no?

Thanks!

GO

I think taping while doing rehab exercises would sort of defeat the point.

That certainly makes sense, and is what I would assume, but I was kind of looking for expert opinions, since there are some very knowledgeable people who post here.

Bummer about the pulley, Cracklover... There is an interesting post about H-taping floating around somewhere on this forum. I would suggest taping the fiinger for rehab (either try the H-taping or fig 8). Theraputty is ok, but it has no "recoil" to it, so you would only be strengthening concentrically. Elastics are better, because you could do concentric, static and eccentric strengthening (remember, you are not trying to strengthen just the pulley, but the whole flexor unit). Start off by flexing through as few joints as possible (ie only mcp, pip, pip and dip together, then hammer-grip) and keep the wrist in neutral position.

Slight pain (1-3/10) while doing the exercices are fine. Watch for post-exercice pain. If it is severe or long-lasting, then you over-exerciced. Pain at rest (ie night or morning pain) could indicate an inflammatory process - ice in this case! Use common sense with exercising, light stretches before resisted exercises, etc. Hope this helps Quentin

Okay, it's a month later, and it seems to have healed enough to be able to take a tiny bit of force without pain, and a little more when I'm taping to support the pulley. So I'd like to move on to the active rehab phase.

What are some good rehab exercises I could do to help things along? The more specific the info the better. And in doing such exercises, would it be better to tape to support the ripped pulley, or no?

Thanks!

GO

I think taping while doing rehab exercises would sort of defeat the point.

That certainly makes sense, and is what I would assume, but I was kind of looking for expert opinions, since there are some very knowledgeable people who post here.

Okay, it's a month later, and it seems to have healed enough to be able to take a tiny bit of force without pain, and a little more when I'm taping to support the pulley. So I'd like to move on to the active rehab phase.

What are some good rehab exercises I could do to help things along? The more specific the info the better. And in doing such exercises, would it be better to tape to support the ripped pulley, or no?

Thanks!

GO

I think taping while doing rehab exercises would sort of defeat the point.

That certainly makes sense, and is what I would assume, but I was kind of looking for expert opinions, since there are some very knowledgeable people who post here.

GO

Clinically, I am a fan of taping (or bracing) to support weak ligaments. Functionally, pulleys are ligaments.

Taping sprained ankle ligaments is well-supported for allowing an athlete to participate in sports where the injury would otherwise make it impossible.

I am generally not a fan of bracing or taping to support weak musculature, like say, a back brace for a sore back. We have muscles to support the spine. If the brace is doing the work, the muscles are not. If the muscle is not, it is becoming weaker.

There is no muscle to strengthen which will support a torn pulley. External taping is (IMO) indicated.

I believe in very frequent re-taping, between every burn or maybe two, especially with a fairly fresh injury. Tape stretches.

That is also why you will see NFL running backs getting re-taped every time the team is on defense, not just once per game.

Okay, it's a month later, and it seems to have healed enough to be able to take a tiny bit of force without pain, and a little more when I'm taping to support the pulley. So I'd like to move on to the active rehab phase.

What are some good rehab exercises I could do to help things along? The more specific the info the better. And in doing such exercises, would it be better to tape to support the ripped pulley, or no?

Thanks!

GO

I think taping while doing rehab exercises would sort of defeat the point.

That certainly makes sense, and is what I would assume, but I was kind of looking for expert opinions, since there are some very knowledgeable people who post here.

GO

Clinically, I am a fan of taping (or bracing) to support weak ligaments. Functionally, pulleys are ligaments.

Taping sprained ankle ligaments is well-supported for allowing an athlete to participate in sports where the injury would otherwise make it impossible.

I am generally not a fan of bracing or taping to support weak musculature, like say, a back brace for a sore back. We have muscles to support the spine. If the brace is doing the work, the muscles are not. If the muscle is not, it is becoming weaker.

There is no muscle to strengthen which will support a torn pulley. External taping is (IMO) indicated.

I believe in very frequent re-taping, between every burn or maybe two, especially with a fairly fresh injury. Tape stretches.

Every "burn"? You mean climbing? No way could I climb right now, with tape or without it. Even fully taped, anything more than moderate force applied with that finger makes it hurt. I'm looking for therapeutic exercises to help it. Or perhaps I've misunderstood you?

It is *much* better than it was immediately after the injury, which is why I thought I could start a rehab program.

Bummer about the pulley, Cracklover... There is an interesting post about H-taping floating around somewhere on this forum.

Thanks, I'll look that up. I had been using a fig-8 style of taping to support it recently (no longer need this for light activities like typing, but still need it if I'm going to be lifting anything).

In reply to:

Theraputty is ok, but it has no "recoil" to it, so you would only be strengthening concentrically. Elastics are better, because you could do concentric, static and eccentric strengthening (remember, you are not trying to strengthen just the pulley, but the whole flexor unit). Start off by flexing through as few joints as possible (ie only mcp, pip, pip and dip together, then hammer-grip) and keep the wrist in neutral position.

Any idea where I could get one? Do pharmacies usually carry it, or do I need to order online? I went to the local Wallgreens Pharmacy, but they don't have it. In the meantime, I'll try a particularly squishy stress ball I have.

In reply to:

Slight pain (1-3/10) while doing the exercices are fine. Watch for post-exercice pain. If it is severe or long-lasting, then you over-exerciced. Pain at rest (ie night or morning pain) could indicate an inflammatory process - ice in this case! Use common sense with exercising, light stretches before resisted exercises, etc. Hope this helps Quentin